血管内超声用于颈动脉狭窄诊治的研究

Application of intravascular ultrasound in diagnosis and therapy of carotid artery stenosis

目的评价血管内超声(IVUS)对颈动脉粥样硬化狭窄的诊断和血管内介入治疗的价值。方法本院超声检查显示颈动脉狭窄住院患者17例进行选择性颈动脉造影术(CA)和颈动脉IVUS检查,通过IVUS检查了解病变斑块性质与特征及计算病变血管最大狭窄程度,并对这两种检查结果进行比较。在IVUS指导下支架植入,并观察支架植入前后血管形态学改变。结果CA检测发现狭窄血管21处,偏心性狭窄9处,向心性狭窄12处;IVUS检测发现狭窄血管22处,偏心性斑块17处,向心性斑块5处。病变最窄处血管直径狭窄率IVUS所测值显著高于CA,分别为(66.9±11.2)%与(53.5±12.4)%,两者比较差异有统计学意义(P<0.05)。病变最窄处血管面积狭窄率IVUS所测值显著高于CA,分别为(89.2±12.9)%与(76.1±13.1)%(P<0.05)。颈动脉狭窄支架成形术(CAS)治疗20处血管病变,支架植入均获成功。结论对于CA显示的狭窄病变,IVUS能更准确地判定管腔形态、病变性质及狭窄程度,更有效地指导和评估支架植入。

Objective To evaluate the merits of intravascular ultrasound （IVUS） in the diagnosis of carotid artery stenosis and carotid artery stenting （CAS）. Methods Carotid angiography（CA） and IVUS was used in 17 patients with carotid artery stenosis pre-diagnosed by B-mode ultrasound. The characteristics of the plaques was analyzed by IVUS, and the stenostic morphology and the severity of carotid artery by two techniques were compared. The morphological changes of the carotid artery pre-stenting and post-stenting was evaluated by IVUS. Results Eccentric stenosis in 9 arteries and concentric in 12 ones were found by CA and 17 eccentric plaques and 5 concentric plaques were demonstrated in IVUS. There were significant differences in the parameters of the diameter stenosis rate of injured vessels between CA and IVUS. The value of IVUS was higher than that of CA, （66.9 ± 11.2）% vs （（53.5 ± 12.4）%, （P〈0.05）. The area stenosis rate of IVUS was higher than that of CA, （89.2 ± 12.9）% vs （76.1±13.1 ）%, （P〈0.05）. 20 vascular lesions were treated by carotid artery stenting（CAS）, all of them were successful performed. Conclusion Compared with CA, IVUS can accurately identify the lumen morphology and the plaque characteristics and the severity of stenosis, it is more effectually to guide and evaluate CAS.